About three years ago, I was offered the opportunity of a lifetime: to work remotely from my Troy home office for a New York City-based digital startup that I’d helped launch, writing all day, every day. (It’s not lost on me that I’m now, basically, doing the same for Saratoga Living during the COVID-19 pandemic.) As far as I was concerned, I was living the dream, but soon enough, my lack of interaction with the outside world started to adversely affect my mental health. Full disclosure: I’ve battled anxiety and depression for most of my life and have been in therapy, on and off, for about a decade. So, I went to see my new doctor in Troy and told her that I was feeling blue and that I needed a refill of my anti-anxiety medication, which I’d been prescribed years earlier by my doctor in Manhattan. Much to my surprise, she said she couldn’t help me, instead referring me to Troy’s Samaritan Hospital, which put me through a long, arduous psychological evaluation that, arguably, exacerbated my symptoms. To make a long story short, I didn’t get my meds refilled until I changed doctors months later. The whole process left me feeling like a character from One Flew Over The Cuckoo’s Nest.
While I’d like to believe that my experience happened in a vacuum—that, at my lowest and most vulnerable, I made some grave error in judgement, and that’s why my doctor couldn’t help me—the reality is that that kind of uncomfortable interaction happens all the time. According to the Centers for Disease Control and Prevention, more than a quarter of American adults suffers from some kind of “behavioral health” disorder (the phrase in quotes being a catchall that encompasses mental health issues, eating disorders and addictions). And the reason people like me find themselves dealing with roadblocks to the path to good behavioral health care hinges on several interconnected factors, all seemingly working against one another, says Dan Pickett, co-founder and CEO of aptihealth, a new digital platform and mobile app, which has set out to disrupt how patients, physicians and psychologists interact in the health care space—and save all involved boatloads of time and money in the process.
One of those key factors is the stigma attached to behavioral health issues, which keeps people who are suffering from them from getting the assistance they need before they’re struggling (like I was) or potentially, become a danger to themselves or others. That, subsequently, puts a strain on hospitals and emergency rooms, which are woefully underequipped to help people suffering from behavioral health issues, and those visits end up costing all parties involved a lot more money. (Behavioral health currently has a $200-$300 billion stranglehold on the US health care system.) A second factor is the hair-pulling-out madness that is navigating the health care system in the first place and the lack of an easy handshake between your family doctor and psychologist, both of whom have your well-being in mind but often have no way of knowing what the other has diagnosed or analyzed about your state of body and/or mind. Dr. James Aram, MD, who runs a private family medical practice in Troy, and opted in to the aptihealth platform in 2018, says “it’s widely acknowledged, and it’s certainly true for me, that getting behavioral health care is fragmented, it doesn’t happen quickly, and there’s a paucity of providers.” With more than 30 years of experience under his belt, Dr. Aram says that aptihealth is the first time in his career that he’s seen an organized effort to fold behavioral health and primary health care into one unit, systematically working in favor
of a patient.
That do-si-do between behavioral health and primary care doctors gets even more complicated when medication is involved (see: my situation), as patients can’t get prescriptions from psychologists (PhDs), and have to track down or already be the patient of a prescribing psychiatrist or up-to-speed doctor (MDs). Dr. Aram says that he sees this kind of situation all the time, noting that some physicians, like himself, treat patients with antidepressants, while others are more comfortable referring patients out (as my first Troy doctor did). The other important component missing in this scenario is the actual psychotherapy, which many people who are taking antidepressants take part in. To that point, Dr. Aram says he simply doesn’t have the time to sit down with a patient for 45 minutes to an hour to walk them through what they’d need to do to get proper counseling. In short, aptihealth is cutting out the middleman.
Lastly, this all goes nuclear if you simply need a referral to a behavioral health professional. Say you’re having a nervous breakdown, and a doctor tells you that it’ll take six to eight weeks to get in front of someone who can help—and even that’s not a sure thing. Your options are basically to suffer, give up or get lost in a sea of phone calls, paperwork and red tape at your absolute worst. And maybe hardest to grasp might be the strain all of this puts on the minds of the physicians themselves. “You have a world today where the physicians are burned out because of how much behavioral health is part of their medical practice, but at the same time, it’s very difficult to manage and navigate [the behavioral health care system],” says Pickett. And that, ironically, leads to behavioral health issues among many doctors (a study, published within the last three years, concluded that about 40 percent of physicians were reluctant to reach out for mental health treatment for fear of losing their licenses).
So, how, exactly, does aptihealth work? It exists as both a desktop version and smartphone app, and anyone can sign up for it—though, it helps, dramatically, if you have health insurance and/or your provider has opted in to the platform. To get a better understanding of what it does, let’s relive my earlier, not-so-awesome experience at the doctor through the lens of aptihealth. Assuming my original doctor had opted in to the platform, I would’ve said, “Hey, doc, I’m feeling depressed,” and she would’ve pointed me towards the platform, which would’ve been on my smartphone. From there, I would’ve taken a comprehensive, artificial intelligence-driven, multiple choice behavioral health assessment quiz via the app—as well as been given the ability to tell my own story, privately, to behavioral and primary health care professionals. The health care professionals would’ve then been able to create a personalized treatment plan for me and if, say, I didn’t already have a wonderful therapist, they would’ve helped get me connected to an in-network psychologist, whom I would’ve been able to message, in the app itself, and set up in-person appointments with thereafter (Pickett likens the experience to locking down a restaurant reservation on OpenTable). I could’ve even video chatted with my new psychologist right on my smartphone (the message system and video chat are both Health Insurance Portability and Accountability Act of 1996 [HIPAA] compliant). Most crucial, at least for my purposes, would’ve been that the platform enabled my physician to add a prescriber to my “care team,” who would’ve managed and prescribed me my meds.
So, simply using aptihealth would’ve saved me months of headaches and more than a few copays, among other out-of-pocket expenses along the way. But that was all one big hypothetical. Does it really work, though? Last August, Pickett’s business partner and co-founder, Dr. Alex Marsal, PhD, a behavioral health expert and licensed clinical psychologist who’s had a private practice in Troy for 25 years, along with Joe Kelly, a licensed clinical social worker (now aptihealth’s clinical operations director), completed a six-month case study based on aptihealth’s then-nascent platform. The results (based on 75,000 participants) included these astonishing data: After beginning to use aptihealth, patients made 68 percent less emergency room visits; there was a 44 percent reduction in symptom severity among patients; and overall, physicians saw a 100 percent decrease in patient hospitalizations. It’s clear, then, why Pickett sees aptihealth, which is headquartered in Boston and has a satellite office in Troy, as nothing short of a deus ex machina for the behavioral health care industry. And his record in the Capital Region business world should be all the proof anyone needs that this is nothing short of a world-changing idea.
Pickett, who was born in Troy, raised in Mechanicville and graduated from Rensselaer Polytechnic Institute (RPI), is best known for founding Clifton Park-based tech solutions juggernaut, nfrastructure. After building the company into a billion-dollar powerhouse, with clients such as Starbucks, Disney and adidas, Pickett left his post as president late last year to join aptihealth. (nfrastructure was acquired by West Coast IT giant, Zones, Inc., in 2016.) “I really wanted the next 10 years to be purpose-driven,” says Pickett of his shift to aptihealth. “Building networks is great, but it’s not as profound.” Dr. Marsal echoes Pickett’s sentiment. “We’re using technology to enhance care and disrupt the health care industry, and I think that that’s different than companies that are started from a tech perspective; they see a problem and then they apply technology to fix a clinical problem,” he says. Besides having expertise in the behavioral health care industry, Dr. Marsal was an administrator at Samaritan for a decade and himself launched a successful health care-focused digital business, Vanguard Behavioral Solutions (VBS), a patient assessment and treatment platform, which served as the basis for aptihealth. In the early aughts, Pickett invested in Dr. Marsal’s behavioral health research, which included demonstration studies on various practices in the behavioral health care sector. Despite the majority of his time being devoted to nfrastructure, Pickett gained a keen appreciation for his friend’s work and by 2016, when nfrastructure was sold to Zones, Pickett agreed to stay on for an additional three years and then leave in October 2019. So, about a year and a half before Pickett stepped down at nfrastructure, he was on the lookout for his next big adventure. One night, he, Dr. Marsal and their wives were dining at 15 Church in Saratoga Springs. That evening, apropos of nothing at all—and an unintended harbinger of things to come—Pickett had brought along a bottle of Screaming Eagle wine to share, one of the priciest pours around. In their booth, the pair “talked about the fact that the problem that we’d been working on, scientifically, for 10-plus years was getting bigger and bigger,” says Pickett. And that the two men were confident that they had a unicorn of an idea—one that capital markets investors would fawn over, because it hinged on solving a wide-reaching, global problem. Pickett asked his friend to prove to him that the concept could actually work, with living, breathing patients and doctors. Dr. Marsal tracked down seven primary care practices—55 physicians, with about 100,000 patients in their care—and all of them signed up for aptihealth. Talk about proof of concept. Soon after, the two founded aptihealth, and Pickett became the first seed investor in the project, investing millions of his own dollars in the company. The two were then able to secure $2.5 million in additional venture capital funding. “We really started hitting our stride in late 2018,” says Pickett. “We put the initial team together, and last year, we really started to accelerate the pace.”
Likely, you’re assuming that Pickett and Dr. Marsal have hordes of employees at their beck and call by now. But during its launch year and still at press time, aptihealth had just 12 full-time employees, plus a few dozen contractors. (By year’s end, the headcount could be as high as 50-75 employees, per a company rep.) The current aptihealth staff consists of three types of employees: clinical scientists, like Dr. Marsal, who understand all aspects of behavioral health and how to diagnose it and treat it—as well as circumnavigate the health care system attached to it (MDs and PhDs); clinical engineers, who take that knowledge and tech-ify it at the point of care; and top-flight user experience (UX) engineers, who understand how patients and physicians will interact with the aptihealth platform, and can give it an inviting, consumer-friendly format (among other key hires, the company has added Sean Austin, formerly of music streaming service Spotify, to help build out the UX; and Kori-Ann Taylor as its CMO, most recently director of client services and marketing at Saratoga-based 32 Mile Media).
Even with all the excitement involved in having a potential mint of a company now open for business, aptihealth still has a way to go before it can truly scale. Pickett estimates that aptihealth will need at least $100 million in additional investments to go global. There’s also the critical issue of privacy protection and the seeming pervasiveness of major breaches these days, which have been happening at an alarming rate to corporate giants such as Yahoo and Equifax, and even local conglomerates such as Community Care Physicians, where my wife and I share a primary care doctor. But Pickett is bullish on the platform’s Fort Knox-ness. “Our CTO Mike Martin is deeply experienced in multi-stack security, so the whole aptihealth application runs in Amazon’s cloud, and from a multi-factor authentication perspective, we’ve got everything locked down each step of the way,” says Pickett. “We’ve also got a lot of AI tools that are running so if anything out of the norm should happen, aptihealth immediately locks down.”
All of this might sound like pie-in-the-sky thinking for a tech startup, but Pickett’s damned near sure it’s going to succeed. “The opportunity for this company is massive,” he says. (It’s currently only available to patients in the US.) As far as I’m concerned, the next time I go to my primary care physician, I’m going to suggest her practice signs up for aptihealth. Because I can already see how much easier my future health care interactions could and should be.
